Report • CampusOptics

If you have a safety concern that needs immediate attention contact: the Work Order Center at 630-752-7930 (for needed repairs), Public Safety at 630-752-5911 (for security), or Legal Affairs & Risk Management at 630-752-5688 (for health & safety matters).

If you are an employee of Wheaton College (including student workers), and you were injured on the job, please complete a Work Related Accident Form.

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Name* Required

Additional Location Details

Exact Location

Loading…

Unusal Occurence Questions

When did the incident occur?

What approximate time did the incident occur?

Injured Party Name and Date of Birth

Injured Party Phone Number and Email Address

Injured Party Relationship to Wheaton College

Describe the sequence of events

Was anyone notified about this incident?

Provide Name(s) of Person Notified

Were Photographs Taken at the Scene?

Were there any witnesses to this incident?

Witness Name and Date of Birth

Witness Phone Number and Email Address

Person Who Caused/Suspected of Causing the Occurrence Name and Date of Birth

Person Who Caused/Suspected of Causing the Occurrence Phone Number and Email Address

Was First Aid Administered?

Who administered the First Aid?

Was an AED used?

AED Model # and Serial #

Were Emergency Medical Services (EMS) Called?

Name of Paramedic and Ambulance Number

Was the Injured Party Transported by EMS to a Hospital or Clinic?

Was the Injured Party Transported by Another Means? If so, what?

Was the Injured Party Treated at a Hospital or Clinic?

Name of Hospital or Clinic

Did the Injured Party refuse any of the following, if offered?

First Aid Assistance

EMS Treatment

EMS Transport

Was the Injured Party Treated at Student Health Services (SHS)?

Name of Nurse of Physician

Describe Treatment Provided

Subjective Severity Index

Provide any other information relevant to this incident.

Add Supporting Documents

Add files to upload as supporting documentation along with your incident.